title: Cost-effectiveness of adjuvanted versus nonadjuvanted influenza vaccine in adult hemodialysis patients.
abstract: BACKGROUND
  Currently more than 340,000 individuals are receiving long-term hemodialysis (HD) therapy for end-stage renal disease and therefore are particularly vulnerable to influenza, prone to more severe influenza outcomes, and less likely to achieve seroprotection from standard influenza vaccines. Influenza vaccine adjuvants, chemical or biologic compounds added to a vaccine to boost the elicited immunologic response, may help overcome this problem.
  
  
  METHODS
  Economic stochastic decision analytic simulation model.
  
  
  METHODS
  US adult HD population.
  
  
  METHODS
  The model simulated the decision to use either an adjuvanted or nonadjuvanted vaccine, assumed the societal perspective, and represented a single influenza season, or 1 year.
  
  
  METHODS
  Adjuvanted influenza vaccine at different adjuvant costs and efficacies. Sensitivity analyses explored the impact of varying influenza clinical attack rate, influenza hospitalization rate, and influenza-related mortality.
  
  
  RESULTS
  Incremental cost-effectiveness ratio of adjuvanted influenza vaccine (vs nonadjuvanted) with effectiveness measured in quality-adjusted life-years.
  
  
  RESULTS
  Adjuvanted influenza vaccine would be cost-effective (incremental cost-effectiveness ratio <$50,000/quality-adjusted life-year) at a $1 adjuvant cost (on top of the standard vaccine cost) when adjuvant efficacy (in overcoming the difference between influenza vaccine response in HD patients and healthy adults) ≥60% and economically dominant (provides both cost savings and health benefits) when the $1 adjuvant's efficacy is 100%. A $2 adjuvant would be cost-effective if adjuvant efficacy was 100%.
  
  
  CONCLUSIONS
  All models are simplifications of real life and cannot capture all possible factors and outcomes.
  
  
  CONCLUSIONS
  Adjuvanted influenza vaccine with adjuvant cost ≤$2 could be a cost-effective strategy in a standard influenza season depending on the potency of the adjuvant.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.forename: Randy M
authors.initials: RM
authors.lastname: Stalter
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Bacon
authors.forename: Julie H Y
authors.initials: JH
authors.lastname: Tai
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Bailey
authors.forename: Shanta M
authors.initials: SM
authors.lastname: Zimmer
authors.forename: Michael M
authors.initials: MM
authors.lastname: Wagner
mesh_terms: D000276:Adjuvants, Immunologic / Q000191:economics* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000191:economics* / Q000627:therapeutic use; D007251:Influenza, Human / Q000191:economics* / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics*
chemical_list: D000276:Adjuvants, Immunologic; D007252:Influenza Vaccines